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Changing profile of retinopathy of prematurity
Rajiv Aggarwal1, Ashok K Deorari, R V Azad
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
The incidence of retinopathy of prematurity (ROP) remained stable, but severe ROP cases declined. Effective management of apnea and sepsis is key to reducing ROP risk in premature infants.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Understanding evolving trends in ROP incidence and severity is crucial for optimizing neonatal care.
Purpose of the Study:
- To analyze the changing trends of retinopathy of prematurity (ROP) in a tertiary neonatal intensive care unit.
- To compare ROP incidence and severity between two distinct time periods (1993-94 and 1999-2000).
Main Methods:
- Retrospective analysis of ROP screening data from at-risk neonates.
- Comparison of ROP incidence, stage distribution, and treatment rates between two historical periods.
- Multivariate analysis to identify significant risk factors for ROP.
Main Results:
- Overall ROP incidence showed no significant change between the two periods (20% vs. 32%).
- A significant decrease in severe ROP (Stage III) was observed (46% to 21%).
- The need for cryotherapy also significantly reduced (46% to 8%).
- Apnea, clinical sepsis, and male sex were identified as significant risk factors for ROP.
Conclusions:
- While overall ROP incidence is stable, a decline in severe ROP cases is encouraging.
- Effective management of neonatal apnea and sepsis may play a critical role in reducing severe ROP.
- Continued ROP surveillance and risk factor management are essential in neonatal intensive care units.
Abstract:
The aim of this study was to determine the evolving trends of retinopathy of prematurity (ROP) at a tertiary neonatal intensive care unit. In an ongoing screening programme for ROP, we estimated the incidence of ROP among at-risk neonates in a tertiary care unit. We compared our data over the last 12 months (1999-2000; period II) to the previously published data (1993-94; period I) to study changes in the spectrum of the disease. The overall incidence of ROP in period II was not significantly different from the incidence in period I (32 vs. 20 per cent, p > 0.05). However, a decreasing trend in the proportion of severe ROP (stage III) from 46 to 21 per cent in the later period was noted. The need for cryotherapy also dropped significantly compared with the earlier period (8 vs. 46 per cent respectively, p < 0.05). On multivariate analysis, apnea (p < 0.001; RR = 12.5; 95 per cent CI, 3.03-50.9; clinical sepsis (p < 0.001; RR = 5.7; 95 per cent CI, 1.6-20.7); and male sex (p < 0.001; RR = 6.3; 95 per cent CI 1.6-25.5) emerged as significant risk factors. Although the incidence of ROP is static, the more severe form of the disease (stage III) is showing a decline. Our data suggests that efficient management of apnea and sepsis may be crucial in further minimizing the risk of ROP.